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Dynamic Invasive Hemodynamic Congestion Profile Impacts Acute Myocardial Infarction Complicated by Cardiogenic Shock Outcomes: A Real-World Single-Center Study

Published:November 04, 2022DOI:https://doi.org/10.1016/j.cardfail.2022.10.425

      Highlights

      • Persistent or new congestion within the first 24 hours of cardiogenic shock is associated with worse outcomes.
      • BiV or persistent congestion and higher SCAI stages are associated with worsening hemodynamics.
      • Incorporating hemodynamic and congestion assessment plus SCAI stages in AMI-CS could potentially impact clinical outcomes by optimizing guideline-directed therapies.

      Abstract

      Background

      Cardiogenic shock (CS) commonly complicates the management of acute myocardial infarction (AMI) with high mortality. Pulmonary artery catheter (PAC) monitoring can be valuable for personalizing critical care interventions. We hypothesized that patients with AMI-CS experiencing persistent congestion measure in the first 24 h of the PAC installment would exhibit worse in-hospital survival.

      Methods and Results

      295 patients with AMI-CS, from January 2006-December 2021, first 24 h PAC-derived hemodynamic measures were divided by the congestion profiling and proposed 2022 SCAI classification.
      Biventricular congestion was the most common profile and was associated with the highest patient mortality at all time points (mean 56.6%). A persistent congestive profile was associated with increased mortality (HR=1.85; p=0.002) compared with patients who achieved a decongestive profile. Patients with SCAI stages D/E had higher levels of right atrial pressure (RAP; 14–15 mmHg) and pulmonary capillary wedge pressure (PCWP; 18–20 mmHg) compared with stage C (RAP, 10–11 mmHg, mean difference 3–5 mmHg; p<0.001; PCWP 14–17 mmHg; mean difference 1.56–4 mmHg; p=0.011). In SCAI stages D/E, the pulmonary artery pulsatility index (0.8-1.19) was lower than in those with grade C (1.29–1.63, mean difference 0.21–0.73; p<0.001).

      Conclusions

      Continuous congestion profiling using the SCAI classification matched the grade of hemodynamic severity and the increased risk of in-hospital death. Early decongestion appears to be an important prognostic and therapeutic goal in patients with AMI-CS and warrants further study.

      Graphical Abstract

      Keywords

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